Case Report
Magnetic-Guided Occult Lesion Localization (M-GOLL): An Innocuous and Efficient Technique for Assisting Surgical Resection of Pulmonary Nodules
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The actual location of RMB ostium marked on VBN platform as a target (<span class="elsevierStyleItalic">green dot</span>) in <span class="elsevierStyleItalic">Panel C</span> and <span class="elsevierStyleItalic">D</span>. Correlation of bronchoscopic (<span class="elsevierStyleItalic">Panel E</span>) and virtual bronchoscopic images (<span class="elsevierStyleItalic">Panel F</span>) showing the postulated site of RMB ostium based on <span class="elsevierStyleItalic">best-guess</span> strategy (<span class="elsevierStyleItalic">red arrow</span>) and the actual site by virtual bronchoscopic navigation (<span class="elsevierStyleItalic">green dot</span>). The actual location of right main bronchus ostium identified by virtual bronchoscopic navigation pre-procedure showing subtle mucosal puckering with converging fibrotic bands (<span class="elsevierStyleItalic">Panel G</span>) and four months later which shown patent neo-RMB with minimal granulation tissue (<span class="elsevierStyleItalic">Panel H</span>).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Sze Shyang Kho, Mona Zaria Nasaruddin, Jamalul Azizi Abdul Rahaman" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Sze Shyang" "apellidos" => "Kho" ] 1 => array:2 [ "nombre" => "Mona Zaria" "apellidos" => "Nasaruddin" ] 2 => array:2 [ "nombre" => "Jamalul Azizi" "apellidos" => "Abdul Rahaman" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622003386?idApp=UINPBA00003Z" "url" => "/03002896/0000005800000011/v2_202304171313/S0300289622003386/v2_202304171313/en/main.assets" ] "itemAnterior" => 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"identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Edisson Israel" "apellidos" => "Rodríguez Alvarado" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "María Carolina" "apellidos" => "Gutiérrez Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "General Thoracic Surgery Chair of Dpt., Marina Salud Hospital, Denia, Alicante, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Thoracic Surgery Dpt., Marina Salud Hospital, Denia, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Interventional Radiologist, Marina Salud Hospital, Denia, Alicante, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2219 "Ancho" => 3175 "Tamanyo" => 762259 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical cases: non-palpable and small pulmonary lesions.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Small pulmonary nodules and ground-glass opacities are commonly found in medical practice, because of the widespread use of computed tomography (CT), and the overcoming lung cancer screening is expected to increase their diagnostic rate.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Magnetic tracing is a recent technique found to be very useful for sentinel-node-biopsy and non-palpable breast cancer<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a>. Since its design, it was meant for targeting lesions on any soft tissue organ, including thyroid and lung, with European Certification (CE) and FDA (United States Food and Drugs Administration) clearance for long term implantation, but no previous experience has been reported before for pulmonary nodules on medical literature.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Describing the technique</span><p id="par0015" class="elsevierStylePara elsevierViewall">M-GOLL is similar to radio-guided-occult-lesion-localization (ROLL), requiring a CT-scan guided-punction.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Depending on the size and location, a surgical-steel-seed marker is placed on the pulmonary nodule or nearby, always on the surgical-resection site.</p><p id="par0025" class="elsevierStylePara elsevierViewall">A game-changing advantage of M-GOLL, is that the targeting can be done immediately before surgery, the same as hours, days, weeks and maybe months, without any impact on the surgical procedure.</p><p id="par0030" class="elsevierStylePara elsevierViewall">We used Sysmex-Endomag's magnetic tracker (Sentimag®) for the seed's tracing. It's important to take into consideration, that none metal instruments should be used near the tracker's end. Plastic or titanium forceps might be used to manipulate lung tissue during this phase. Titanium staples used on previous surgeries do not interfere with the magnetic tracing.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Once the steel-seed has been located, the surgeon can proceed with the lung resection according to the surgical plan, and is able to correct or check with the tracker as many times as needed.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case based discussion</span><p id="par0040" class="elsevierStylePara elsevierViewall">In order to explain different technical variations, and better expose M-GOLL's potential usage, we present four different cases (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#1:</span> 62yo female patient, 2 years disease free after a right-upper lobectomy for a T3N0M0 adenocarcinoma, suspicious for relapse for a 12<span class="elsevierStyleHsp" style=""></span>mm sub-solid pulmonary nodule on the right lower lobe.</p><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#2:</span> 57yo male patient with a 13<span class="elsevierStyleHsp" style=""></span>mm lung colon metastasis on the 6th left segment, at 2<span class="elsevierStyleHsp" style=""></span>cm from the chest-wall.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#3:</span> A 53yo male with a previous SIVATS right lower lobectomy for a T3N0M0 adenocarcinoma, was diagnosed of pulmonary nodules on the left upper lobe. CT-guided core-needle biopsy reported lung cancer relapse and showed 2 more nearby micro-nodules of 5.17 and 5.68 millimeters, located at 3<span class="elsevierStyleHsp" style=""></span>cm from the chest wall.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#4:</span> A 72yo female with bilateral pulmonary metastases. One of them was subsolid, with a size of 5<span class="elsevierStyleHsp" style=""></span>mm on the left-upper lobe, located at 1.5<span class="elsevierStyleHsp" style=""></span>cm from the chest wall.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="par0065" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#1:</span> The pulmonary nodule involved part of 6th and 10th segments. A wedge pulmonary resection was made with no lesion found on palpation, but a positive tracer mark. The final histopathological study reported a 15<span class="elsevierStyleHsp" style=""></span>mm subsolid pulmonary adenocarcinoma, so the patient was sent to medical oncology for treatment.</p><p id="par0070" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#2:</span> The surgery was programed 4<span class="elsevierStyleHsp" style=""></span>h after placing the steel marker, but surgery was not possible because of unexpected events with the previous patient. The surgery was delayed for a week and went uneventful by single-incision VATS (SIVATS) approach, with no difference for delayed surgery.</p><p id="par0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#3:</span> Given the small size and deep location of the nearby nodules, a SIVATS anatomical segmentectomy for the 4th and 5th segment was performed. The highest-located nodule was marked, to place the parenchymal resection limit.</p><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Case#4:</span> The pulmonary nodule was not visible nor palpable, but traceable with M-GOLL for a wedge resection. Histopathological study reported a 1<span class="elsevierStyleHsp" style=""></span>cm subsolid non-palpable metastasis of intestinal adenocarcinoma.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="par0085" class="elsevierStylePara elsevierViewall">We found M-GOLL a very feasible procedure, and think that its ease of use may improve surgical resection of small and non-palpable pulmonary nodules. It has similar complication rates than standard guide-wire and other tracing techniques, due to the implantation method<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2-5</span></a>.</p><p id="par0090" class="elsevierStylePara elsevierViewall">In comparison with other widely used techniques, it has no risk of dislocation and avoids radioactive isotope manipulation. Its placement is easier than liquid tracers without pleural leak risk, and the biggest advantage is, that the steel seed may be placed even for weeks before surgery.</p><p id="par0095" class="elsevierStylePara elsevierViewall">After a systematic review of the known medical databases, we found no other previous experience reported on G-MOLL for lung lesions. So, we expect that this brief communication will be a basis for larger series, in order to search for other possible advantages or disadvantages referable to the procedure.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Authors’ contributions</span><p id="par0100" class="elsevierStylePara elsevierViewall">RA and GR contributed substantially to de study, design, execution, analysis and development of the M-GOLL technique.</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Guarantor</span><p id="par0105" class="elsevierStylePara elsevierViewall">José Alejandro González García, MD.</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Ethics statement</span><p id="par0110" class="elsevierStylePara elsevierViewall">Consent to participate was obtained from each patient on the clinic, when explaining the procedure and surgical plan.</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Funding</span><p id="par0115" class="elsevierStylePara elsevierViewall">None.</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">None declared.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:12 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Describing the technique" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Case based discussion" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Conclusions" ] 5 => array:2 [ "identificador" => "sec0030" "titulo" => "Authors’ contributions" ] 6 => array:2 [ "identificador" => "sec0035" "titulo" => "Guarantor" ] 7 => array:2 [ "identificador" => "sec0040" "titulo" => "Ethics statement" ] 8 => array:2 [ "identificador" => "sec0045" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0050" "titulo" => "Conflict of interest" ] 10 => array:2 [ "identificador" => "xack662803" "titulo" => "Acknowledgments" ] 11 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2219 "Ancho" => 3175 "Tamanyo" => 762259 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Clinical cases: non-palpable and small pulmonary lesions.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sentinel node biopsy using a magnetic tracer versus standard technique: the SentiMAG Multicentre Trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. 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Nakajima" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00595-018-1742-8" "Revista" => array:6 [ "tituloSerie" => "Surg Today" "fecha" => "2019" "volumen" => "49" "paginaInicial" => "311" "paginaFinal" => "315" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30474752" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Image-guided preoperative localization of pulmonary nodules for video-assisted and robotically assisted surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. McDermott" 1 => "F.J. Fintelmann" 2 => "A.J. Bierhals" 3 => "D.D. Silin" 4 => "M.C. Price" 5 => "H.C. Ott" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1148/rg.2019180183" "Revista" => array:6 [ "tituloSerie" => "Radiographics" "fecha" => "2019" "volumen" => "39" "paginaInicial" => "1264" "paginaFinal" => "1279" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31419188" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack662803" "titulo" => "Acknowledgments" "texto" => "<p id="par0130" class="elsevierStylePara elsevierViewall">We thank the Sysmex-Sentimag Spanish product management group representatives Oscar Dejean, Eduard Flaques and Sergi Lopez, who facilitated our experience with Sentimag with their assessment and orientation on its use.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/03002896/0000005800000011/v2_202304171313/S0300289622003350/v2_202304171313/en/main.assets" "Apartado" => array:4 [ "identificador" => "93865" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005800000011/v2_202304171313/S0300289622003350/v2_202304171313/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289622003350?idApp=UINPBA00003Z" ]
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